Prevalence and Severity of Dental Caries and Fluorosis in 8 Year-old Children With or Without Fluoride Supplementation / Prevalencia y Severidad de Caries Dental y Fluorosis en Niños de 8 Años con o Sin Suplementos de Flúor

ABSTRACT: One of the most effective and studied measures in the prevention of caries is the use of fluoride, which has the property to reduce their incidence and severity. In Chile, 75 % of the population receives it the drinking water. In 1984, WHO recommended the use of milk as an alternative vehicle. In Chile, the Fluoridated School Feeding Program (FSFP) was introduced in 1994, using this alternative in rural areas without fluoride in water. The objective of the study was to compare prevalence and severity of dental caries and dental fluorosis in 8-year-old children of four state schools: two with fluoride supplementation in drinking water or milk and two without any fluoride program. Epidemiological, descriptive, comparative, observational and cross-sectional study with a sample of 140 8-year-old children, with no systemic diseases and who had lived in the same place since birth: 50 schoolchildren from an area with fluoridated water; 40 from an area with fluoridated milk and 50 from a zone without supplementation of F. The percentage of caries-free children was obtained with the methodology described by the WHO, for severity the dmft and DMFT indexes were used. To quantify the prevalence and severity of dental fluorosis, Dean Index was used. 38 % of the children were caries-free in the community with fluoridated water (CFW); 0 % in the community with fluoridated milk (FSFP) and 10 % in the community with no fluoride program established (CNF). The difference between CFW with CNF is statistically significant (p<0.05). The prevalence of fluorosis is significantly higher for CFW (48.8 %) than FSFP (35 %) and CNF (16 %). Conclusion: The contribution of fluoride in drinking water causes a decrease in the prevalence and severity of dental caries in children of 8 years of age, and an increase in the prevalence of dental fluorosis.

RESUMEN: Una de las medidas más efectivas y estudiadas en la prevención de caries es el uso de fluoruros, que tiene la propiedad de reducir su incidencia y severidad. 75 % de la población chilena lo recibe al incluirlo en el agua potable. La OMS en 1984 recomendó el uso de leche como un vehículo alternativo. En Chile, el Programa de Alimentación Escolar con leche fluorada fue implementado en 1994 como alternativa en zonas rurales sin fluoruro en el agua. El objetivo de este estudio fue comparar la prevalencia y severidad de la caries dental y la fluorosis dental en niños de 8 años en tres escuelas públicas, con suplementación de fluoruro en el agua potable o en la leche y con aquella que no tiene ningún programa de fluoración. Estudio epidemiológico, descriptivo, comparativo, observacional y de corte transversal con una muestra de 140 niños de 8 años, sin enfermedades sistémicas y que han vivido en el mismo lugar desde su nacimiento: 50 escolares en el área con agua fluorada, 40 en el área con leche fluorada y 50 en la zona sin suplementación de fluoruro. El porcentaje de niños libres de caries fue obtenido con la metodología descrita por la OMS, usando índices ceo-d y CPO-D para evaluar severidad. Para cuantificar la prevalencia y severidad de la fluorosis dental se ocupó el índice de Dean. Niños libres de caries fueron 38 % en la comunidad con agua fluorada (CWF); 0 % en la comunidad con leche fluorada (FSFP) y 10 % en la comunidad sin programa de fluoración (CNF). La diferencia entre CWF y CNF es estadísticamente significativa (p<0,05). La prevalencia de fluorosis es significativamente mayor en CWF (48,8 %) que FSFP (35 %) y CNF (16 %). La contribución del fluoruro en el agua potable causa una disminución en la prevalencia y severidad de la caries dental en niños de 8 años, y un aumento en la prevalencia de fluorosis dental.

The future of pediatric dentistry education and curricula: a Chilean perspective.

BACKGROUND: A meeting was organised to consolidate a network of researchers and academics from Australia, Brazil, Chile, the UK and the USA, relating to Early Childhood Caries (ECC) and Dental Trauma (DT). As part of this meeting, a dedicated session was held on the future of paediatric dental education and curricula. Twenty-four paediatric dentistry (PD) academics, representing eight Chilean dental schools, and three international specialists (from Brazil and Latvia) participated in group discussions facilitated by five members of the ECC/DT International Collaborative Network. Data were collected from group discussions which followed themes developed as guides to identify key issues associated with paediatric dentistry education, training and research. DISCUSSION: Participants discussed current PD dental curricula in Chile, experiences in educating new cohorts of oral health care providers, and the outcomes of existing efforts in education and research in PD. They also, identified challenges, opportunities and areas in need of further development. This paper provides an introspective analysis of the education and training of PD in Chile; describes the input provided by participants into pediatric dentistry education and curricula; and sets out some key priorities for action with suggested directions to best prepare the future dental workforce to maximise oral health outcomes for children. Immediate priorities for action in paediatric dentistry in Chile were proposed.

Oral health care for patients with epidermolysis bullosa--best clinical practice guidelines.

OBJECTIVE: To provide the users with information on the current best practices for managing the oral health care of people living with EB. METHODS: A systematic literature search, in which the main topic is dental care in patients with Epidermolysis Bullosa, was performed. Consulted sources, ranging from 1970 to 2010, included MEDLINE, EMBASE, CINAHL, The Cochrane Library, DARE, and the Cochrane controlled trials register (CENTRAL). In order to formulate the recommendations of the selected studies the SIGN system was used. The first draft was analysed and discussed by clinical experts, methodologists and patients representatives on a two days consensus meeting. The resulting document went through an external review process by a panel of experts, other health care professionals, patient representatives and lay reviewers. The final document was piloted in three different centres in United Kingdom, Czech Republic and Argentina. RESULTS: The guideline is composed of 93 recommendations divided into 3 main areas: 1) Oral Care--access issues, early referral, preventative strategies, management of microstomia, prescriptions and review appointments 2) Dental treatment: general treatment modifications, radiographs, restorations, endodontics, oral rehabilitation, periodontal treatment, oral surgery and orthodontics, and 3) Anaesthetic management of dental treatment. CONCLUSIONS: A preventive protocol is today's dental management approach of choice.

Caries and fluorosis in the Santiago metropolitan region in Chile: The impact of the fluoridation of the water / Cárie e fluorose na região metropolitana de Santiago, Chile: impacto da fluoretação da água

PURPOSE: To assess the damage and the prevalence of caries and fluorosis in children and adolescents in the metropolitan area after 8 years of drinking water fluoridation and to compare them with the baseline study. METHODS: This was a prevalence study. The sample was selected using two-step probability sampling and stratified according to socioeconomic level. Subjects included 2,323 schoolchildren aged 6 to 8 years and 12 years living within the metropolitan region. The parents of all students provided consent and were previously included in the study. The subjects were clinically examined by calibrated dentists, who used World Health Organization (WHO) screening criteria and indicators to determine the presence of caries and dental fluorosis. RESULTS: No cavity damage was found in 23.68 percent of the children. The average dmft was 3.18 for children aged 6 to 8 years. The DMFT was 0.59 in children aged 6 to 8 years and 2.6 in children 12 years compared with the baseline study. These differences were statistically significant. There were also significant differences in the DMFT index for each socioeconomic status group. The average number of dams was higher among children of low socioeconomic status. Of the studied children, 14.3 percent of children had dental fluorosis. Fluorosis was very mild in 12.35 percent of the cases, mild in 1.98 percent and moderate in 0.26 percent. There were no cases of severe fluorosis (classified according to Dean's index). CONCLUSION: We conclude that after 8 years drinking water fluoridation in the metropolitan area, the number of children with no history of caries has increased by approximately 100 percent. The number of cases significantly affected by caries has also decreased significantly. The incidence of dental fluorosis has increased, but to milder degrees.

OBJETIVO: Avaliar o dano e a prevalência de cárie e fluorose em crianças e adolescentes na região metropolitana do Chile, após oito anos de fluoretação da água potável, em comparação com o estudo de base em 1996. METODOLOGIA: Desenho: estudo de prevalência. A amostra probabilística, estratificada por nível socioeconômico, constituiu-se de 2.323 escolares de 6-8 e 12 anos na Região Metropolitana. Todos os alunos foram clinicamente examinados por dentistas calibrados, utilizando critérios de seleção e indicadores propostos pela OMS para determinar cárie e fluorose dentária. RESULTADOS: Cerca de 24 por cento das crianças estavam livres de cáries. A média de CPOD foi de 3,18 em escolares de 6 a 8 anos. O CPOD foi de 0,59 em crianças de 6 a 8 anos e de 2,6 em crianças de 12 anos em relação ao estudo de base, sendo essas diferenças estatisticamente significativas. Houve diferenças significativas devido ao nível socioeconômico, sendo que os valores médios foram maiores em crianças de baixo nível socioeconômico. Cerca de 14 por cento das crianças apresentaram fluorose dentária, em geral de grau muito leve. CONCLUSÃO: Após 8 anos de fluoretação da água potável na região metropolitana, observou-se um aumento de 100 por cento de crianças sem história de cárie e significativa diminuição de danos. A fluorose dentária aumentou, mas em graus mais leves.

Periodontal status and treatment needs of children from 6 to 8 years old in the Santiago Metropolitan Region of Chile / Condição periodontal e necessidades de tratamento em crianças de 6 a 8 anos na região metropolitana de Santiago, Chile

PURPOSE: To evaluate the periodontal status and the treatment needs of Chilean school-children METHODS: Prevalence study. Sample: 1,637 schoolchildren from 6 to 8 years old belonging to 26 communes of the Santiago Metropolitan Region of Chile, stratified according to socioeconomic level in accordance with the 2003 CASEN survey (National Socioeconomic Characterization Survey). Periodontal status was estimated using the Community Periodontal Index of Treatment Needs (CPITN) and following the recommendations of the WHO (World Health Organization), along with the records of the Clinical Criteria of Gingival Inflammation. Data were analyzed using a chi-square test. RESULTS: Gingivitis prevalence was 68.42 percent, a result that is higher than the national prevalence (P<0.01; 95 percent CI=0.66-0.70). The prevalence increased with age (P<0.01) but was similar in both sexes (P=0.838). Prevalence was relatively constant among three socioeconomic levels (P=0.417). According to the CPITN, gingivitis prevalence was 29.57 percent: 27.49 percent consisting of children with gingival hemorrhage and 2.08 percent consisting of children with gingival calculus. The treatment needs of this population are that 27.49 percent of children require oral-hygiene instruction, and 2.08 percent need oral-hygiene instruction and subgingival and supragingival scaling. CONCLUSION: The gingivitis prevalence found in this study was higher than the national proportion in Chile.

OBJETIVO: Avaliar a condição periodontal e as necessidades de tratamento de crianças escolares chilenas. METODOLOGIA: Estudo de prevalência. Amostra: 1637 crianças escolares de 6 a 8 anos de idade pertencentes a 26 comunidades da região metropolitana de Santiago, Chile, que foram estratificadas de acordo com o nível socioeconômico conforme o levantamento 2003 CASEN (National Socioeconomic Characterization Survey). A condição periodontal foi estimada usando o índice Community Periodontal Index of Treatment Needs (CPITN) e seguindo as recomendações da Organização Mundial de Saúde (OMS), juntamente com os registros de critérios clínicos de inflamação gengival. Os dados foram analisados por testes qui-quadrado. RESULTADOS: A prevalência de gengivite foi de 68,42 por cento, resultado que é maior que a prevalência nacional do Chile (P<0,01; 95 por cento CI=0,66-0,70). A prevalência aumentou com a idade (P<0,01), mas foi similar em ambos os sexos (P=0,838). A prevalência foi relativamente constante entre os três níveis socioeconômicos (P=0,417). Para CPITN, a prevalência de gengivite foi de 29,57 por cento: 27,49 por cento com sangramento gengival e 2,08 por cento s com cálculo gengival. As necessidades de tratamento desta população foram de 27,49 por cento de crianças que necessitavam de instrução de higiene bucal e 2,08 por cento que necessitavam de instrução de higiene bucal e raspagem supra e subgengival. CONCLUSÃO: A prevalência de gengivite neste estudo foi maior que a proporção nacional no Chile.

[Streptococci mutans: a semi-quantitative method to assess the risk to oral infection in preschool Chilean children]. / Streptococci mutans: método semi-cuantitativo para establecer el rango de riesgo de infección bucal en niños preescolares chilenos.

BACKGROUND: Salivary infection due to Streptococci mutans is considered the main microbiological risk factor for the initiation of dental caries. AIM: To evaluate a semi-quantitative method to assess Streptococci mutans salivary infection and compare it with the existing quantitative method. PATIENT AND METHODS: Saliva samples were obtained from 650 preschool children aged 2 to 6 years old using a TYCSB liquid medium for counting Streptococci mutans. Results were compared with quantitative cultures. RESULTS: There was a 99.3% linear correlation coefficient between both methods. The correlation coefficients with dental caries prevalence were 97% for the semi quantitative method and 90% for the quantitative method. CONCLUSIONS: The semi-quantitative method to assess oral infection with Streptococci mutans, is accurate enough to be used in population studies and oral infection prevention programs in developing countries.